{"id":2972,"date":"2020-12-11T09:00:00","date_gmt":"2020-12-10T22:00:00","guid":{"rendered":"https:\/\/blog.amt.org.au\/?p=2972"},"modified":"2020-12-10T10:42:04","modified_gmt":"2020-12-09T23:42:04","slug":"testing-massage-research","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2020\/12\/11\/testing-massage-research\/","title":{"rendered":"Testing Massage Research"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>By Chris Wheeler<\/strong><\/h2>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Background<\/strong><\/h4>\n\n\n\n<blockquote class=\"wp-block-quote has-text-align-left is-layout-flow wp-block-quote-is-layout-flow\"><p><em>In the 2012\/2013 budget, the then Federal Labor Government announced that there would be a review of the government private health insurance rebate for natural therapies. The purpose of the review was to examine the evidence of clinical efficacy, cost effectiveness and safety and quality of natural therapies with the ultimate aim of regulating which natural therapies would continue to receive the government rebate. AMT\u2019s 200-page submission to the 2013 Natural Therapies Review can still be downloaded <\/em><a rel=\"noreferrer noopener\" href=\"https:\/\/www.amt.org.au\/downloads\/submissions\/CMO-submission-PHIR.pdf\" target=\"_blank\"><em>here<\/em><\/a><em>.<\/em> <em>Those of you who have been in the industry for more than 5 years will no doubt recall the <\/em><a rel=\"noreferrer noopener\" href=\"https:\/\/www.amt.org.au\/downloads\/news-items\/AMT-Media-Release-Natural-Therapies-Review.pdf\" target=\"_blank\"><em>outcome of that review<\/em><\/a><em> \u2013 remedial massage and myotherapy were the only therapies that remained eligible for a rebate, and around 15 other therapies, including reflexology and aromatherapy were dropped.<\/em><\/p><cite>Rebecca Barnett, AMT CEO<\/cite><\/blockquote>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Could Do Better?<\/strong><\/h4>\n\n\n\n<p>Having a background in science and a post-graduate degree that gives me knowledge of research methodology, I got to thinking about the Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance. I found it a little embarrassing to have the evidence returned with a \u2018could do better\u2019 mark. As a scientist, I fully understand the need for firm evidence, especially when it involves the allocation of funds. It is difficult to argue against the case that any funding or rebate should be appropriately targeted. So, what do we do?<\/p>\n\n\n\n<p>The Government Report details <em>\u201cpaucity of good quality studies of sufficient size<\/em>\u201d (page 106), \u201c<em>low quality evidence<\/em>\u201d (page 102), \u201c<em>the evidence base for massage therapy is not of high quality and many of the individual studies were poorly designed and conducted<\/em>\u201d (page 110), \u201c<em>the majority of SRs <\/em>(systematic reviews)<em> included in this overview were of low quality<\/em>\u201d (Page 103) and an overriding criticism is the lack of randomised controlled trials (RCT). Obviously what we do is address these issues. Easy!<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Subjective<\/strong><\/h4>\n\n\n\n<p>First, let\u2019s consider the way a lot of \u2018evidence\u2019 is collected. A large amount is subjective:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>How does the client \u2018feel\u2019 afterwards?<\/li><li>What is the pain on a 1-10 scale?<\/li><\/ul>\n\n\n\n<p>This may seem to be a measurement, as you are able to compare two numbers, but how does it actually compare?<\/p>\n\n\n\n<p>I deal with a couple of footballers. If I hit them with an engineer\u2019s mallet, they would probably give it a 3 out of 10. As therapists, we can argue that it doesn\u2019t really matter as long as the client feels better but that will not satisfy the report\u2019s authors. There is also the assumption that any improvement after an intervention is the result of that intervention. Tempting, but the same logic tells you that walking under a ladder brings you bad luck.<\/p>\n\n\n\n<p>There may be some form of pre-test, post-test. How far can you move it before the treatment and how far can you move it after? Again, tempting but can we be sure it is the intervention that has caused a difference? <a href=\"https:\/\/catalogofbias.org\/biases\/hawthorne-effect\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Hawthorne Effect<\/a> tells us a person\u2019s behaviour is apt to change when they know they are part of a study or being observed or measured.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>The RCT<\/strong><\/h4>\n\n\n\n<p>The randomized controlled trial (RCT) is referred to as the \u2018gold standard\u2019 of research. OK, let\u2019s go for gold \u2013 what are we controlling and what is random?<\/p>\n\n\n\n<p>A variable is anything that can affect the outcome of an experiment or trial. If we are going to compare groups, all variables must be identical in each group, except one group will have one variable different \u2013 they will receive the treatment. This is the control aspect. If there is any difference in the groups, it can only be the result of the intervention.<\/p>\n\n\n\n<p>Easier said than done.<\/p>\n\n\n\n<p>How many variables come into play when dealing with massage treatment on a person? Is everybody having exactly the same tissue targeted in exactly the same way with exactly the same technique and exactly the same amount of pressure? Are some of the subjects also attending an exercise class or others swimming every other day and mobilising the tissue? Go on, try it. How many other variables can you list? I\u2019ll bet there are plenty without really trying hard.<\/p>\n\n\n\n<p>Random groups mean that a representative sample of the population is allocated to either a treatment group or a control group. Easy enough? Well, not really. People who seek out massage treatment are, overwhelmingly, people who believe in the effects of treatment, so our population is skewed to begin with. Groups are \u2018blinded\u2019. In a drug trial, this would mean that the subjects don\u2019t know if they are taking the drug or a placebo. In a \u2018double blind\u2019, the subjects and data gatherers don\u2019t know who is taking the drug and who receives the placebo. The conclusions then come from statistical analysis and all is revealed at the end. Well, good luck blinding somebody to a massage treatment!<\/p>\n\n\n\n<p>Our study must have <strong>validity<\/strong> \u2013 are we actually testing what we say we are testing and actually measuring what we say we are measuring? It sounds simple but you will be surprised by the number of studies criticised for lack of validity.<\/p>\n\n\n\n<p>Our studies must also be <strong>reproducible<\/strong> \u2013 if the same treatments are given to a similar group of people, they would give similar results. This means our methods are <strong>reliable<\/strong> in that they have eliminated the possibility that the results are due to chance.<\/p>\n\n\n\n<p>It also requires a large number of subjects; studies of 10 or 20 are not enough. True reliability requires thousands. Our gut feeling or heartfelt belief that \u2018massage works\u2019 will not cut it.<\/p>\n\n\n\n<p>Realistically, the very nature of our profession makes RCTs very difficult. One purpose of this article is to provide a starting point for our thinking, \u2018well what do we do?\u2019 Is it realistic to have many therapists targeting exactly the same tissue, using exactly the same technique, controlling many other variables? Not really.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>If not RCT, then what?<\/strong><\/h4>\n\n\n\n<p>Fortunately, there are alternatives and we must examine them with a view to designing studies that pass the standards for validity, reliability and objectivity, so providing a firm evidence base for our work. It requires us to collect data but, more importantly, carefully consider the data being collected to ensure it is meaningful. It requires an education campaign for therapists interested in providing evidence:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>What do we do?<\/li><li>How do we do it?<\/li><li>What will we measure?<\/li><li>How will we measure it?<\/li><\/ul>\n\n\n\n<p>Without health fund rebates, we may lose clients due to financial concerns. In that case, to continually attract clients, fees would have to be reduced but unfortunately our overheads will not decline with our fees.<\/p>\n\n\n\n<p>An alternative way of thinking is, how dependent are we on health funds? Does it really matter to our clients if we don\u2019t give health fund rebates? If they are satisfied with our services without a rebate, do we need to worry that much? Personally, about one third of my clients ask about provider numbers. Is this worth examining further and actually collecting data? As I said before, I\u2019m just trying to start the debate. As a scientist I like empirical evidence but, as a therapist, if my clients are happy, I\u2019m happy!<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">The Final Word<\/h4>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p><em>It took a while for the Liberal\/National Coalition Government to enact the changes from the 2013 Review but, since the transition, there has been a mounting backlash. Despite frequent howls to the contrary from within the natural therapies industry, the private health insurance industry isn\u2019t thrilled with the changes. The private health funds rely heavily on natural therapies to attract young, healthy people into taking out private health insurance.<\/em> <em>Fast forward to 2019, when the Government decided to commence <\/em><a href=\"https:\/\/www.health.gov.au\/ministers\/the-hon-greg-hunt-mp\/media\/review-of-natural-therapies-for-private-health-insurance\"><em>a review of the natural therapies review<\/em><\/a><em>. The current review is ongoing, albeit COVID interrupted. In AMT\u2019s pragmatic view, it is likely to deliver a different outcome for many of the therapies that were dropped in the first review.<\/em><\/p><cite>Rebecca Barnett, AMT CEO<\/cite><\/blockquote>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>About the Author<\/strong><\/h4>\n\n\n\n<div class=\"wp-block-image is-style-rounded\"><figure class=\"alignleft size-large is-resized\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310.jpg?resize=196%2C260&#038;ssl=1\" alt=\"\" class=\"wp-image-2974\" width=\"196\" height=\"260\" srcset=\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=768%2C1024&amp;ssl=1 768w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=225%2C300&amp;ssl=1 225w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=1152%2C1536&amp;ssl=1 1152w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=1536%2C2048&amp;ssl=1 1536w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=750%2C1000&amp;ssl=1 750w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?resize=300%2C400&amp;ssl=1 300w, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/20201203_111310-scaled.jpg?w=1920&amp;ssl=1 1920w\" sizes=\"auto, (max-width: 196px) 100vw, 196px\" \/><\/figure><\/div>\n\n\n\n<p><em>Chris Wheeler taught Biology, Chemistry and Physical Education since the time the syllabus was written in Latin and is now in his second life working as a remedial therapist in the Jervis Bay area. Chris can now be relaxed before going to work, relaxed at work and relaxed when finished and he doesn&#8217;t have to mark any of it. Chris is energised by the enthusiasm and dedication of the therapists with whom he works.<\/em><em><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Is the value of massage only determined by the quality of the research? Scientist, educator and massage therapist Chris Wheeler shares his thoughts.<\/p>\n","protected":false},"author":1,"featured_media":2977,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[32,2,20],"tags":[703,702,104,47,121,10,69,257,81],"class_list":["post-2972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-amt","category-professional-practice","category-research","tag-chris-wheeler","tag-christopher-wheeler","tag-massage","tag-massage-therapist","tag-massage-therapists","tag-massage-therapy","tag-massage-therapy-research","tag-private-health-insurance","tag-private-health-insurance-rebate"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/12\/Screenshot-2020-12-10-102042.jpg?fit=952%2C603&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":1566,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/04\/08\/news-flash-department-of-health-announces-new-natural-therapies-review\/","url_meta":{"origin":2972,"position":0},"title":"News flash:          Department of Health announces new Natural Therapies Review","author":"admin","date":"08\/04\/2019","format":false,"excerpt":"Six days after the new private health insurance legislation came into effect removing a number of natural therapies from the private health insurance rebate, the Department of Health has announced an updated review of Natural Therapies. Confused? So are we ...","rel":"","context":"In &quot;Clinical Practice&quot;","block_context":{"text":"Clinical Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/clinical-practice\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/NTW-argh.jpg?fit=750%2C442&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/NTW-argh.jpg?fit=750%2C442&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/NTW-argh.jpg?fit=750%2C442&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/NTW-argh.jpg?fit=750%2C442&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":1449,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/03\/01\/remedial-massage-and-myotherapy-still-eligible-for-health-insurance-rebates\/","url_meta":{"origin":2972,"position":1},"title":"Remedial Massage and Myotherapy still eligible for health insurance rebates","author":"admin","date":"01\/03\/2019","format":false,"excerpt":"You could be forgiven for thinking that the Government's April 1 deadline for the exclusion of many natural therapies from the private health insurance rebate is a joke. Fortunately, it's not one that impacts remedial massage or myotherapy ...","rel":"","context":"In &quot;AMT&quot;","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?fit=924%2C544&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?fit=924%2C544&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?fit=924%2C544&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?fit=924%2C544&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":336,"url":"https:\/\/blog.amt.org.au\/index.php\/2017\/11\/22\/final-update-private-health-insurance-rebates-for-remedial-massage-and-myotherapy\/","url_meta":{"origin":2972,"position":2},"title":"Final update: private health insurance rebates for remedial massage and myotherapy","author":"admin","date":"22\/11\/2017","format":false,"excerpt":"AMT has received official confirmation today from the Minister for Health, Hon Greg Hunt, that remedial massage and myotherapy will continue to be eligible for the private health insurance rebate.","rel":"","context":"In &quot;News and events&quot;","block_context":{"text":"News and events","link":"https:\/\/blog.amt.org.au\/index.php\/category\/news-and-events\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/11\/private-health-insurance-1200x72-1.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":178,"url":"https:\/\/blog.amt.org.au\/index.php\/2017\/10\/13\/announcement-private-health-insurance-rebates-for-remedial-massage\/","url_meta":{"origin":2972,"position":3},"title":"Announcement: private health insurance rebates for remedial massage","author":"admin","date":"13\/10\/2017","format":false,"excerpt":"Health Minister, the Hon Greg Hunt, will be announcing a raft of sweeping reforms to private health insurance later today. Among the reforms, Minister Hunt will announce the removal of the government rebate on natural therapies from 1 April 2019. At this stage, we assume that this includes the removal\u2026","rel":"","context":"In &quot;News and events&quot;","block_context":{"text":"News and events","link":"https:\/\/blog.amt.org.au\/index.php\/category\/news-and-events\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":3879,"url":"https:\/\/blog.amt.org.au\/index.php\/2024\/05\/20\/10-reasons-to-be-excited-about-amts-new-research-resource\/","url_meta":{"origin":2972,"position":4},"title":"10 reasons to be excited about AMT&#8217;s new research resource","author":"admin","date":"20\/05\/2024","format":false,"excerpt":"Drum roll please ... Unveiling the new AMT research resource: your backstage pass to the cutting-edge of massage therapy, where evidence meets innovation in one shiny, digital package.","rel":"","context":"In &quot;AMT&quot;","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2024\/05\/Library.png?fit=1200%2C673&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2024\/05\/Library.png?fit=1200%2C673&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2024\/05\/Library.png?fit=1200%2C673&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2024\/05\/Library.png?fit=1200%2C673&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2024\/05\/Library.png?fit=1200%2C673&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":180,"url":"https:\/\/blog.amt.org.au\/index.php\/2017\/10\/13\/update-private-health-insurance-rebates-for-remedial-massage\/","url_meta":{"origin":2972,"position":5},"title":"Update: private health insurance rebates for remedial massage","author":"admin","date":"13\/10\/2017","format":false,"excerpt":"We're safe! The Department of Health Fact Sheets that have been published in connection with the announcement of sweeping private health insurance reforms confirm that remedial massage has not been removed from the rebate scheme. Woot! We await official confirmation of this from Minister Hunt's office but it's probably time\u2026","rel":"","context":"In &quot;News and events&quot;","block_context":{"text":"News and events","link":"https:\/\/blog.amt.org.au\/index.php\/category\/news-and-events\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2972","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/comments?post=2972"}],"version-history":[{"count":5,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2972\/revisions"}],"predecessor-version":[{"id":2979,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2972\/revisions\/2979"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media\/2977"}],"wp:attachment":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media?parent=2972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/categories?post=2972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/tags?post=2972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}